Provider Demographics
NPI:1295831691
Name:MIZUKAWA, JOHN HIDEO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HIDEO
Last Name:MIZUKAWA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DIAGONAL ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2878
Mailing Address - Country:US
Mailing Address - Phone:435-673-1554
Mailing Address - Fax:435-674-9967
Practice Address - Street 1:10 DIAGONAL ST
Practice Address - Street 2:SUITE 204
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2878
Practice Address - Country:US
Practice Address - Phone:435-673-1554
Practice Address - Fax:435-674-9967
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1362261223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery